Episode 209 Author Hazel Keedle, PhD + Birth After Caesarean: Your Journey to a Better Birth

We are honored to have Dr. Hazel Keedle join us today all the way from Australia! Hazel is the author of Birth After Caesarean: Your Journey to a Better Birth. She has more than 25 years of experience as a clinician both in nursing and midwifery, an educator, and a published researcher. Her work remains rooted in her desire to strengthen and empower women.Hazel tells us how her own VBAC birth journey lit a fire that led to the completion of her doctorate degree and her book. Everything in her book is ESSENTIAL for VBAC-hopeful mamas and is all backed with evidence-based research.We know you will LOVE listening to Hazel. She is so gracious and such an invaluable asset to the birth world. This episode is a must-listen and her book is most definitely a must-read for all!Additional linksBirth After Caesarean: Your Journey to a Better Birth by Hazel Keedle, PhDHazel’s Instagram: @hazelkeedleHazel’s Facebook: https://www.facebook.com/VBACmattersSarah’s Instagram: @sarah_marie_bilger or @entering_motherhoodHow to VBAC: The Ultimate Prep Course for ParentsFull transcriptNote: All transcripts are edited to correct grammar, false starts, and filler words. Meagan: You guys are listening to The VBAC Link and I’m so excited for today’s episode. We have Hazel Keedle today. She’s in Australia and it’s 1:00 a.m. She stayed up all night just to be with us today on this podcast. So grateful for her. We’re going to be time sensitive so we can make sure to get her tucked into bed at a somewhat reasonable hour, but guess what? Today, we have a co-host. A co-host! I’m so excited to start bringing on some co-hosts here and there. Today, we have Sarah and she is one of our VBAC doulas. I’m so excited to have her with us today. Review of the WeekMeagan: Sarah is going to actually do the honors of reading you a review. So go ahead, Sarah. Sarah: Hi, yeah. I’m glad to be here. We have a review from Katelyn Bayless. This one is from google and it says, “I honestly can’t recommend The VBAC Link enough. I had my son via C-section in 2021 and even though I’m not pregnant with number two yet, I feel so ready and even excited for when that time comes because of all of the stories and education from The VBAC Link. I have been binging the podcast for the past couple of weeks and I have a note on my phone that is specifically for VBAC resources and education that has been mentioned on this podcast. “I am looking into providers and planning on starting interviewing some soon. I can’t tell y’all enough. Thank you for all that you do and I hope one day I can share my VBAC story.”Meagan: Oh, I love that. I love that. Well, today’s episode is going to have some more resources for you for sure. Hazel Keedle, PhDMeagan: We are coming to you from The VBAC Link. We have a guest from Australia. We’re so excited to have her. We’re so, so excited. We actually just connected here. We are connecting for the first time, I should say today, but Hazel, our guest today, just connected with us about a week or two ago. You guys, she is so amazing. It’s 1:00 a.m. and she is in Australia recording right now, so I just want to give her a huge shoutout and thank you for being with us at 1:00 a.m. Oh my goodness. I told her I probably would have been, “Nope. Let’s find another time,” but here she is. She is so dedicated at 1:00 a.m. recording with us and I cannot wait to share with you this wonderful, wonderful human being. We are going to jump right into it because again, it’s 1:00 a.m. I don’t want to take too much time but I wanted to introduce her quickly. This is Hazel Keedle. She is a lecturer of midwifery and completed her PhD in 2021 at Western Sydney University in Australia. Hazel has more than 25 years of experience as a clinician in nursing and midwifery, educator, and researcher. Her research is – it might as well be 1:00 here Hazel. Hazel: You’re doing great.Meagan: Her research is recognized internationally and focuses on midwifery practice, education, and women’s experience in maternity care. Hazel is passionate about improving support for women during pregnancy, birth, and early transition to mothering. She is amazing. Right here in my very hands, I am holding a book that she wrote. It’s called Birth After Caesarean: Your Journey to a Better Birth by Hazel Keedle. I definitely am going to suggest this and we are going to talk more about her book here in just a minute, but again, I don’t want to take too much of her time so we are going to jump right into it and turn the time over to you to share all of your wonderful knowledge and of course, your story. Hazel: Sure, okay. Well, thank you for having me here. I really don’t mind waiting up for you. Okay, so yeah. My name is Hazel Keedle and I’m originally from the U.K., but I moved to Australia 20 years ago now with a backpack and I never left. I came over here as a nurse and then I trained to be a midwife while I was here. I was kind of destined. My granny was a midwife in England and she told me that I would be one, so I followed what she said and I became a midwife here. And then, I wasn’t particularly interested in vaginal birth after Cesarean at that point. I was just trying to get my head around what being a midwife was and what it meant. I quickly met my husband during my UgradG* as a midwife. We quite quickly got together and had a baby which was a planned home birth but ended up that he was being breech and I ended up having an emergency Cesarean because in my area at the time– this was 15 years ago– there wasn’t anyone who supported breech vaginal birth. I knew that I would have to have a Cesarean. I didn’t have a great experience and I didn’t do too well with my health afterward. But then, which was not planned at all, I got pregnant again very quickly. There were only 4 months between my Cesarean and getting pregnant. When I did find out, which was a few months after that, so I was breastfeeding, I had to think about what I was going to do and I really didn’t want to have a Cesarean. My whole first experience was the most hospitalized home birth you can have. I had pneumonia at 34 weeks with my first and then I had a Cesarean and I had mastitis and a childhood fever, so I was in the hospital three times. Meagan: Oh my goodness. Hazel: I was really sick and I really did not want to go through that again, but I also wasn’t sure if I would get support to have a VBAC because there would be 13 months between them or 14 months, I thought, at that point. I did lots of reading. I was a midwife by this point and I dug my head into the numbers. I read the only book that was out there which was The Silent Knife which as you know, is very old and it was very old then, but it was really good at getting me the statistics. I then dated my reading. For a whole weekend, I shut myself in a room and just read and read and read and read. I came out of it freaked out because a paper had come out that year that said if it was less than 6 months between a Cesarean and conception, then you had a 2.7% chance of uterine rupture compared to less than 1%. I got a bit freaked out by those numbers. I came up to my hubby who is a very rational numbers man and I said, “I can’t do it. I can’t do it. I can’t have a VBAC.” I told him the numbers and he said, “You’ve got over a 97% chance of everything being fine.” I was like, “Well, yeah.” It was more dangerous and get in a car and drive to the hospital. Why don’t you just go for a VBAC?I adopted his idea and I thought that it was a great idea. I became dedicated to having a VBAC at that point. I didn’t realize at the time it would shape my future career and life goals, but I stuck my head in the sand. I avoided antenatal care to be honest because I didn’t want to hear the negativity but I was a midwife, so I was able to get someone to listen to my baby and did my blood pressure every time I went to work. I did plan a home birth for my VBAC, but all of my team couldn’t be there at the time, so I transferred in. I had to fight during my labor. There was just lots of coercion, lots of “you must have your baby by 4:00 or you’re going into a Cesarean”, and I had to just keep fighting. It was so hard to keep fighting when you are in labor. They also knew I was a midwife. I trained there, so I couldn’t understand why I had to fight so hard. And then I actually pushed her out of my vagina at 4:00 on the dot. Meagan: Oh my gosh, no way. Hazel: Yeah. The time they were going to take me into theater was her birth time. It was amazing. I didn’t know I could feel that high after doing something that was so hard, but I did and it left me with a couple of questions when I looked back and reflected on how I felt. First of all, I wondered if there were any other women who felt as amazing as I did. I really was on cloud nine. I felt like I was healed and that all of the medical stuff I had after my first was gone. But with that came a question of how does any other woman in Australia manage to have a VBAC with that much drama and with that much negativity during labor?Meagan: Yeah and pressure. Hazel: Yeah and I was a midwife. I could see through it, but how did other women who didn’t have that knowledge? So I was left with those questions. I was at a community forum. We had a lot of access issues up here to our local maternity and there were lots of petitions and community action. I went over to one of the forums. I shared my VBAC story in that forum and there was a professor of midwifery there who said, who I’d never met before, “You know, you’re a midwife. I think you should research this.” I stayed in contact and then about a year later, I started doing research with her. She was my supervisor for both my Master’s Honors and then my PhD. Now, we work together on a lot of projects. So yeah. It was sharing my story in that location that started my research career. Well, I think having a VBAC started my research career but that started my formal research career. Now I’m here. She’s about to turn 14 and I have done a Master’s, a PhD, five or so papers on VBAC, maybe more, and written a book. So that’s my story in a nutshell. Meagan: Those are amazing things. And written a book. It’s so funny because you were like, “Yeah, it started,” but I think it had been with you for a while and then that inspired you and gave you the extra oomph. It was like, “Now I’ve gone through this and experienced this. How can I change this? How can I change this for everyone else?” I always had this desire for birth and a passion for babies. I would have wanted to be a labor and delivery nurse, and then I had my first C-section and was like, “Oh. That wasn’t really what I wanted or what I envisioned.” Hazel: Yeah. Meagan: And then after my second, learning more about doulas and birth, and really the options, then also going through that second Cesarean, although it was healing and everything, just having a different experience, I was like, “Yeah. This is what I’m doing. This is what I want to do.” It’s like it was always in you and it was always in me, but these experiences that we’ve had have lit the first. Hazel: Yeah, it became the drive. I’ve always been interested in research. I got an Honors degree when I was a nurse back in London, and so I had a bit of a passion for research and for reading research, but I think you have to have that real drive and reason for going on such a big path. And yeah, definitely. For me, it was not even how amazing I felt. It was just that question of, did other women feel that? Is it hard for everyone?There was one point when I had stayed overnight. I wish I hadn’t. I wish I had gone straight home, but I had been coerced to stay overnight in the hospital. Midwives would be coming in and saying, “Are you the VBAC woman?” I thought, “What is this? Is this a zoo and I’m a prized animal that they are coming in to stare at?” It made me think that it actually was quite rare then to have a VBAC here. It was really so rare that they had to come in and go, “Are you the VBAC woman?”Meagan: “Are you the VBAC woman?” Yes. Hazel: Yeah. But I hadn’t learned much about it in my training. I was working in the low-risk units, so we didn’t offer VBAC in the hospital I was working in, so it was quite a rarity for me as well. Meagan: Yes. So tell me more about VBAC in Australia. Tell me more about what it’s looking like, what it’s seeming like, and what you’ve learned through all of your education. I would love to know. We talked about this in the beginning. I’m just here in Utah. We are actually very fortunate. We have a high VBAC rate here. I mean, Cesarean rates are still through the roof in general in my own opinion, but we still have a higher VBAC rate and we still have to fight for it. It isn’t as uncommon, but I’d love to know more about your research and what you’re seeing there in Australia. Hazel: Yeah. So what is your VBAC rate, out of interest, in Utah?Meagan: I’m trying to remember the exact. I will look it up. Hazel: I’m trying to think that the US in general is about 12% isn’t it the last time I checked the numbers?Meagan: Yeah, that does sound right. Hazel: Interestingly, I do a lot of presentations on VBAC. When you look across the world, they really do vary from Finland with, I have a 50%, down to across to you guys at 12%. We match you. We actually don’t have the high European numbers. We have 12% as well. Meagan: It says 23.9%. Hazel: Okay, so that’s pretty good. I wish we had that. Meagan: Yeah, so it says in 2020, well, oh my gosh. 21.3% were Cesarean, but vaginal birth after Cesarean from 2017-2020 in Utah averages 23.9% overall. Hazel: Yeah. Meagan: And then it breaks it down within the cities here. Hazel: Which is pretty good. I mean, I know that’s not consistent across the U.S. because the national number comes right down. We do have varieties over here and those varieties are down to the model of care and access. So here in Australia, we have a public maternity system or a public hospital system that is paid through the taxpayer. In that system, where everyone gets free health care, they will be able to access a few different models depending on what’s available in their area. They might have a midwifery group practice where they could see the same midwife throughout and there would be a few of them that were on call for free. It’s part of the hospital service, but that is relatively new. That has really been rising in the last few years as the health services are increasing those models. We have the standard antenatal care which is where women see whichever midwife is on duty or whichever doctor is on duty and whoever is in the labor ward will look after them during labor and whoever is on the ward would look after them postnatally. We call it “standard care” but we also call it “fragmented care” because you see somebody different all of the time. Then we have– so outside of the hospital system, we have some smaller ones for first nations women, and for migrant women, there are some specific models as well. But then outside of the hospital system, we do have privately practicing midwives who are able to prescribe medications, get some money back from Medicare, and offer home birth services. Some of them also have visiting rights in hospitals. That is more state specific. We have more ** there than in any other state here in Australia for the visiting rights. Meagan: So then are you able to come over if a transfer were needed to happen and things like that, they could come over and perform their care? Hazel: Yeah, they could have an agreement with the local hospital, but that’s a growing thing and it’s more popular in some states than in others. Where I am, which is New South Wales, which is where Sydney is, there’s only really one hospital that offers that in such a very big state. Meagan: Yeah. Hazel: And then we also have the private hospital as well where you would be through a private obstetrician. You would get that continuity, but it’s obstetric care, not midwifery care. You may or may not see a midwife during your antenatal period and then you will have midwives along in the labor ward or in the private hospital, but with the private obstetrician you signed up for. So we’ve got a few different models of care and what we do know from the studies that have been done, the VBAC rates do vary across those models of care. They are higher with privately practicing midwives, so a lot of women who choose home birth are choosing it after a Cesarean and that’s what I did my first study on which was their experiences. Then we have good rates in midwifery models of care such as the midwifery group practices and then we have low rates in private hospitals. They have higher repeat Cesarean rates and a lower VBAC rate in private hospitals with continuity of obstetric care. That’s really how it looks. But obviously, we are a very big country with a lot of areas in between, so we will have hospitals that maybe don’t offer birthing services, but a lot of our remote communities are a bit like Canada where all of them, I say in areas of Canada, they have some birthing in-country services. We are still a bit behind on that, so it really is a variety of services, but in most metropolitan hospitals, you’d get a private model, a public model, and midwifery models within that. Meagan: Yeah. Oh my gosh. I love it. I wish so badly that I had the capabilities or I guess I was in a time in my life where I didn’t have little, like little kids, where I could bounce around to not only different states but different countries and somehow observe birth and learn birth around the world. That is this dream of mine that I could understand birth from all areas other than just little Utah here. I have a doula partner who just came from Texas and birth is so different here in Utah than it is in Texas. What you’re describing is so different. Obviously, there are similarities all around. We hear all of these stories and there are definite similarities. It’s birth, but the way care is and everything, so yeah. One day. One day maybe I’ll be able to bounce around in life, but I love hearing that. Hazel: That’s right because only then you’re limited then to really what is published and so some other countries that have higher VBAC rates– just across from us is New Zealand where they have a midwifery model of care and the numbers we can get from them, they don’t have national data on this, they seem to have much higher VBAC rates to us, but then they aren’t published very much on it, so it’s really hard to know. Unless you’re there, it’s hard to get a sense of what’s going on. Meagan: What’s really going on, what they’re doing, and why do they have such a high rate? Hazel: Yeah, yeah. Meagan: Other than maybe midwifery care. Hazel: There are some studies out there, especially in Europe, there are some studies that looked into the culture and how different that is, but not enough. Not enough to really give us an idea. Meagan: Absolutely. So, Ms. Hazel, I would love for you to share more about your book too. You have so many amazing things in this book. I’m going to hurry and just flip over to the table of contents, but it reminds me a lot about our VBAC course. It covers so many incredible things, these topics. Obviously, your VBAC journey is in there, your research journey which I think is amazing, your PhD journey, birth trauma, and experiences and symptoms of birth trauma which are so important. We don’t talk about that enough. Seeking help and debriefing– again, something we don’t talk about enough. How to access debriefing. I don’t know if you want to cover any of that, but that’s so important right there. You have so many things in this book. Do you want to cover some of your highlights? Sarah and I are both here in the states, but we would love to know more about this amazing book. By the way, listeners, we’re going to have a link for this book if you want to purchase it and give it a read because it’s going to be amazing for you. I promise you. Hazel: Oh thank you. Well, my publishers are in the U.S., so when I was writing it I very much had the U.S. in mind, Australia, and the U.K., so even when I looked at any resources in the book, I tried to find U.S. ones as well. Meagan: Yeah, I noticed. YOu have some Lamaze and everything in here. You have tables of words broken down and it does have U.S. things. That is something, I think, that is so amazing because a lot of our listeners are in the U.S. so it’s super nice to be able to read something and have some resources for here where they are. Hazel: Yeah. The idea behind the book was I was towards the end of my Ph.D. journey and I used a methodology called feminist critical theory. Part of that is that you give back your research. You get your research. You get your data from women in the community, but you want to give back to transform that culture for the better. When I was really evaluating, “Well, how do I do that?” When I was writing my thesis, I was like, “Well, how am I giving back to my community?” I had research papers and I know people read research papers. You guys do and then you translate that evidence into your doula course. A lot of people do that. But I thought, “Maybe that’s not everyone.” When I did my Australian VBAC survey, I asked what kind of resources people used, and there was a real want to have more books out there. I wondered if I could have this crazy pipe dream of writing a book and then I had the opportunity to do that, so I submitted my thesis in the October and by the December, I had signed a book contract. I was really keen while it was all fresh in my head to get it all out and down on paper.I think lockdowns were in my favor because I had to take leave because it was building up. I couldn’t go anywhere so it was like, “Well, I will just sit and write this book then.” That’s really how I used my time to do it. I put it together as my findings of my PhD. One of the first papers I wrote on my PhD journey was looking at all of the evidence that was out there. The title of the paper was, “The journey from pain to power.”That was a thread that went through all of my PhD journey. When I was then looking at, “Well, how do I write this book?” The term “journey” was very high up there. I thought, “Well, I go on that journey from pain to power.” That first thing is that pain and that is that previous Cesarean. One of the things I found out from my studies was that usually in the community, we have about a third of women say “yes” to experiencing birth trauma. That’s the full state of birth trauma which includes psychological birth trauma. When I asked that question in my VBAC surveys– so all of these women have had at least one previous Cesarean– that was ⅔ of women that suggested birth trauma. We already know we have a highly traumatized group of women who have had a previous Cesarean, so that’s why I started with that. I think it’s really important. It certainly is. I was a home birth midwife for many years. I know you need to work that out and talk about it, and debrief about it before. You’ve got to work at that past to be able to look forward to the future. Meagan: Yeah. Well, and even recognizing it. Hazel: Yeah, that’s a great one. Meagan: Sometimes, it’s hard to recognize that you look at your experience as traumatic because I feel like so many times, we are mentally trained to tell ourselves, “Oh, we had a safe and healthy baby, so no. It’s fine.” They suppress their trauma down. They’re like, “No, I was fine. It’s fine.”Sarah: We’re led to believe that as well. Hazel: Yeah, absolutely. That’s why I really brought in quotes and what it can look like for women and quotes from the stories that had been shared with me for people to go, “Maybe that is what I experienced. Maybe those symptoms are what I am experiencing.” I start that chapter off with, “Go grab yourself, in pure English style, go grab yourself a cup of tea and a chocolate bar because this chapter will be tough,” just to recognize that this might not be the easiest one. It might not be where people want to start off with. They might go back to that. But yes. I started off with that pain and then I used what I found through my PhD and what I did in my qualitative. So in my PhD, I had qualitative and that moved into quantitative. So the qualitative is all of the feelings, experiences, and exploration, and then the quantitative is all of the stats and the numbers. When I did the qualitative, what I did was I had this crazy idea of designing an app. Women, after their appointments with their healthcare provider, would come home and record their experiences on the app. They would do that after every appointment and then I interviewed them afterward as well. I had some really rich data. I had 52 recordings. I’m so grateful to those women. I’ll be forever indebted to those women. Then I had all of these interviews as well, so I had these really rich stories. We use that term in qualitative is rich data. Sarah: These were appointments leading up to their birth or after in the postpartum period after their Cesarean? Hazel: Right, this is during their pregnancy. Sarah: Okay.Hazel: So they were planning to have a VBAC. That’s what their plan was and then they would go and see their healthcare providers and then they would do recordings for me. They were given some prompts and questions, but it became very organic like it was more like a journal. They would start going, “Hi, Hazel. I’m so many weeks now and this is what just happened.” It was a really novel way. The research hadn’t been done like that before, so it was really interesting. What I was able to do was a narrative analysis which was comparing all of their stories against each other to look for commonalities and differences. What I found is that there were these four factors that impacted how they felt after the birth because I interviewed them all after the birth as well. Those four factors, if they were really positive on those four factors across them and they had a cumulative effect. One had an impact on the other. They felt better about their birth experience regardless of the birth experience. If they felt lower on those four factors, they were more devastated after their birth experience.It didn’t mean that those who had a vaginal birth didn’t feel more positive than those that had a repeat Cesarean because it kind of was that as well, but there was a lot of resolution that could come when you had a repeat Cesarean, and felt higher in those factors. Those factors are then what I go into in the book. There’s a chapter dedicated to each one of those factors. They are having control, so having control over your choices, your wishes, and your birth outcomes. Then there’s having confidence, so having confidence in your ability to have a vaginal birth after a Cesarean, but also, having confidence in your healthcare providers’ belief in you. That was quite surprising for me how pertinent that was. Women really wanted that. It makes sense, doesn’t it? You really want that person to believe in you and believe that you can do what it is that you want to do. And then there’s having a relationship, so that was the relationship that you have with your healthcare provider whether that’s one that is developed such as continuity of care or whether it’s with a different person each time, and even then, not all continuity is the same and that really came out in the study. And then the last one is being active in labor. That seemed a bit of a strange one to add on, but women who felt they were really able to do everything that they wanted to do during labor and birth, being as active as they could, as upright as they could, felt better after their birth experience. If they then ended up with a repeat Cesarean, then they still felt very positive because they had done everything that they could compared to not having the opportunity to be upright and vocalizing that. Meagan: Yes, yes. We have found that. I have found that personally in my group of doulas. We have found that even if it doesn’t end the way they want, there are bumps and curves. It’s labor and birth, but along the way, if they felt like they were in charge and were able to be in the positions they wanted and call the shots a little bit more, overall after, they felt immensely more positive and happy about their experience. Hazel: Yeah, absolutely. That’s it. In the book then, I really go into what they all mean. The control chapter might take some people by surprise because I actually know a lot of women, especially when they are reflecting on their previous Cesarean which may have been, let’s just take probably the most common example these days. Induction, they’re having their first baby, they get close to the date, post dates, they get encouraged to have an induction. The induction doesn’t quite go to plan. They have a cascade of interventions and have a Cesarean. When they are then planning for the next birth before or during the pregnancy, one of the common themes is getting armed with knowledge. It’s like, “Okay. Now I need to know everything about labor, birth, and pregnancy. I really want to be able to call the shots.” There’s a bit of grieving in that time of, “Why did I say yes? Why didn’t I say no?” A bit of self-blame. I think as women, we are kind of hardwired to blame ourselves for everything, especially blaming our bodies because we are never quite right. The media never lets us think we are right because we are either too big or too small or our boobs are not quite right or whatever. Meagan: Right.Hazel: There’s nothing to make us feel better and then we blame ourselves for not being able to stand up against the patriarchal medical system. I actually start the control chapter looking at the impact of the patriarchy in medicine and especially in obstetrics and how the different waves of feminism have impacted that and also the impact of reproductive justice which is something that is obviously very important in the U.S., but also over here with our host nations’ women and migrant communities that have come to Australia. I look at all of that and really frame it to go, “You know, it’s actually not your fault. It’s actually really hard to stand up for yourself and say no when you are at the bottom of a really oppressive ladder.” Not to come and say, “Well, you can’t do anything,” because then I explore all of the ways of what you can do to help that and actually how you need all of those factors together to really build your position. But almost to take that guilt off and also understand where we’ve got to today with a hospital-based maternity system, why it is like it is, and the impact of all of those different changes in society that have got to where we are today. So yeah. Those are the different chapters. Some of them have activities that you can do. There are a few guess righters in there. And then one of my favorite parts, probably because I didn’t have to write it, but I put a Facebook post out and asked for women who had any VBAC stories that they wanted to print in the book. I wanted a VBAC with just something a little bit different or complicated risk or whatever. I have got 12 stories of women from around the world including the U.S. who’ve had VBAC with something a little bit different there. It might be after multiple Cesareans like your story or it might be at home or it might be with a larger body which, as we know, gets a lot of stigma in maternity care. There’s one that is a VBAC after a uterine rupture. There’s one after a classical scar. There are all of these different stories at the back of the book in full with pictures, but I also weaved them into some of the chapters earlier as well. I love those stories. Some are short. Some are in poem form and some are really long. I just kept them as they were and put them in the book. Just really so women can identify and go, “Maybe I’m not quite sure what Hazel is saying,” and then they get to that story and they are like, “Oh, actually I really relate to that person.”Meagan: Yeah. That’s one of the reasons why we’re here on The VBAC Link podcast, right? All of these stories, some of them you might not connect to as deeply, and then some you’re like, “Oh my gosh. That’s me. I felt that. I had that. That’s my story. It’s like they’re taking it out of my own mouth.”Hazel: Absolutely. It is so important. Meagan: We’ve had that many times where it’s like, “Whoa. That was almost creepy how similar those births were,” and then to be able to connect and be like, “But look. They went on and they did it. This is what they did.” It’s so empowering. Just flipping through these beautiful pictures is absolutely stunning. Absolutely stunning pictures. I’m sure these stories are going to, again, relate to so many people out there that may not even know that they’re going to relate to them until they read them. Hazel: Yeah. I do mention in the– oh my gosh. I’m testing myself on which chapter that one’s in now. I think it might be Confidence about really relating to stories and listening to podcasts. I mention that you really need to tap into your peers because we have very large social media groups now and pages to follow full of positive VBAC stories. That’s important in there. I do also add there, it does say that the title is Birth After Cesarean. I do throughout the book look at, you are choosing the best birth for you. You need to prepare for both, but you may either have or choose a gentle Cesarean. There is a chapter in there as well about what a gentle Cesarean is, what evidence says, and maybe some of the things you might think of if you have a repeat Cesarean. There is that part of it as well because I explore how important it is to really if you’re going to be in control of everything or have more control, then you have to be aware of all options that might happen and be able to still have the best birth for you regardless of that outcome. Meagan: Yeah. We just posted– we reposted I should say– from Dr. Natalie Elphinstone. I think that is how you say it. Hopefully, I’m not butchering her last name. She’s from Australia actually. She’s an OB and she posted this video of a gentle Cesarean where the mom was actively involved in giving birth to her baby with her own hands. Hazel: Yeah. Meagan: For me in my Cesareans, both of them, my arms were strapped down in a T and after my second daughter was born, they undid the one arm and I did have skin-to-skin. I was able to hold her with that one arm, but watching this video was captivating. It’s a 30-second thing, but I watched it probably 40 times because I’m like, “Oh my gosh.” I looked at the mom. I looked at the baby. I looked at everyone around her. There was no curtain. She was able to be totally a part of her birth. I’m like, “Yes. This is what we need.” I literally texted a midwife here in Utah. I’m like “I know I’m a really small fish in a big ocean, but let me know if there’s anything I can do from my end to start bringing this option to people.” We got so many messages after like, “Whoa. How can I get that? What do I need to do?” It looks like in Australia, there are multiple videos of this happening. Hazel: I will add that it’s not common and it really does depend on who your OB is. Meagan: Exactly. Hazel: But a few years ago, one of my dear friends did her PhD as a video ethnography of skin-to-skin in theater. She was videoing Cesareans and seeing really what happens to what enables skin-to-skin in theater and what doesn’t. It was really fascinating. She was one of my PhD buddies. One of the Cesareans she saw was a gentle Cesarean with the woman reaching down to grab her baby. She wrote this beautiful article, but it was actually in a midwifery college magazine that doesn’t exist anymore. I could say that she had written it, but I couldn’t find my copy of it. I emailed because we are friends. I emailed her and I said, “Look. Do you have a PDF copy because I really want to read it?”She sent it to me. I read it. I wrote about it in that chapter and then I sent the chapter to her. I said, “Could you just read it to make sure that I’ve said all the right things?” because that’s her expert area. She was happy with what I had written, so that was good. Yeah. It really is down to providers. But really, the more women that ask for it, the more pressure there will be to explore it. There are a lot of resources and videos out there now that can show people how to do it. Meagan: And how to do it and that it is possible. Hazel: Yeah. Meagan: I think sometimes it’s like, “No. That’s impossible. It’s a sterile environment. We can’t have extra bodies in the operating room.” But look. Hazel: The woman’s already there. There’s not going to be an extra body. Meagan: Right. Hazel: And really, the ones that I’ve seen really, they will do the surgical scope with their hands. They will have double gloves on so when they get to the point of needing to reach down, they can take that first pair of gloves off, and then you’ve got the sterile ones on underneath. There are lots that can be done. Even just lowering the screen. There’s often still a screen there, but it’s lowered so they can reach down and then take the baby, and then it can go back up while they do the suturing. Meagan: Absolutely, yeah. Hazel: There are ways it can be done, but it’s just having people understand why. I remember being in an OB’s office with a client, a woman I was caring for. She was exploring her options after having a Cesarean. She mentioned having a gentle Cesarean. His attitude was, “Well, if I offer that, then nobody will want to plan a VBAC.” I was like, “That’s actually not going to happen. Don’t worry. It’s just giving an option to women. Women still really want to have a vaginal birth after Cesarean. That’s not going to go down. Your rates are not even that high anyways so don’t stress. This is what you can do to support them.” But yeah. That was an excuse for not wanting to go there because it sounds a little bit too hard. Meagan: Mhmm. Sarah: Yeah. That just goes back to sharing our stories too because I feel like without sharing those experiences like we were saying, you’re not going to know what your options are if you’re not being informed about them. If others are doing this and more people are asking for it, then it’s going to open that door and allow other people to be in control of what they want for their birth. Meagan: Exactly. Hazel: And throughout the book, it really is based on evidence. I am a researcher with a very large library of articles and I did dive into them. Straight after the trauma chapter, I go into what the evidence is for the different choices. I have a really deep dive into uterine rupture and then what was meant to be part of a chapter actually ended up on its own which was Can I Have a VBAC If…? and then I look into different scenarios or issues that potentially people will say, “Can I have a VBAC if I’ve got this?”So that is all evidence-based with numbers and going through what current data is out there. Meagan: Right. There are a lot of percentages in your book. I love it. There are graphs. You may not think that this may impact care, but she has this, it’s Figure 2 in the book. It’s talking about the length of time for pregnancy appointments under different models of care. You may not right now think the length of an appointment matters, but I can tell you right now firsthand from experience that when I had with my VBAC kiddo, I switched care at 24 weeks. I had an OB and he was great. I seriously loved the guy. He’s wonderful and I still think he’s wonderful. But then I switched care to a midwifery model-based care. The difference between my visits and again, OBs will spend time, but for me, the difference between my visits was incredible. I actually looked forward, really looked forward to visits with my midwife. I was always greeted with a ginormous hug. She never walked in without giving me a big hug and saying, “How are you doing? Really, how are you?” and then would sit down. We would just have a discussion. She became my best friend. I could just open up to her. She spent quality time. For me, it really helped me as I was entering into this next stage of birth to feel confident in her. I was so comfortable because of all the time that she spent with me. Hazel: I love that. I do love that graph. That came out of my VBAC in Australia survey. We asked what model of care they had and then I asked, “What was the time spent at your appointments?” When we looked at the data, it was just so obvious that the shorter time frame, so maybe 5-15 minutes was certainly with obstetric-led care, and then the 20 minutes plus– certainly, with the privately practicing midwives it was more, and then an hour usually was with the midwifery models of care. That was important because relationships take time. In that relationship factor, you need to have someone by your side who understands your wishes and your trauma if you have some which, as I said, ⅔ of women did, and understands what you want, what you are planning for, and what you are hoping for. Just understanding you and how you tick. Certainly, in my years as a continuity of care midwife, in all models of care, you really, for me as a midwife, I really want to know the person that I’m caring for so that I can see those changes, those really subtle changes in behavior even during labor and also you can pick up when things really aren’t quite right and that you might need an extra hug at that time or an extra kind word. Meagan: Yeah. Hazel: That takes a lot of trust. Relationships in healthcare, I believe, should be based on trust and equity. That takes time. The very simple graph, there’s no way I could have done an appointment in ten minutes because I have to have a cup of tea at least. There’s no way I could drink a cup of tea in just five or ten minutes. So sit down, have a cup of tea, and learn about what’s going on.The physical part, feeling the baby, the blood pressure, that you do at some point, but that to me, finding out what’s going on for the woman and how she’s feeling and what’s going on with the family, that is far more important. That takes time. When we saw that in the graph format, it was like, “Oh perfect. That exactly shows what we are saying.” A relationship takes time. Most of us don’t usually marry someone that we haven’t really or get into a relationship with someone that we haven’t spent a fair bit of time with and figured out whether we like them or not. We understand that those relationships are important. I think that when you are only doing something a few times in your life, but you will remember it for the rest of your life, then you really want to choose the team and the support people there. That includes your healthcare provider who completely knows you and completely understands where you’ve come from and where you want to go.Meagan: Oh my gosh. I love it. I feel like I could talk to you until 4:00 a.m. in Australia. Hazel: I’m wide awake now. Meagan: My family and I are getting ready. We are going on a trip this weekend. Your book is going to be in my hand the entire airplane ride there and back because I just want to soak in every single word that you wrote in this book. I am so excited. I definitely encourage everyone. I haven’t even read it yet, but I’ve skimmed it I should say. I started, but I haven’t had time to just sit down and read. It’s going to be amazing I can already tell just by browsing through this and listening to you.Oh my gosh. There is something that you say here. It’s in the very beginning. This is where I have stopped reading, but it was something that impacts me personally because I feel emotional. It’s kind of funny. I felt like this. I felt like a failure and I feel like there are so many times in life when we can– like you said, we beat ourselves up. If it’s not about our body, it’s about something else, but failure is a word that comes in. I actually have recently, today actually, it’s going to be launching. I recently made a reel about failure and how there is no such thing as failure, but this is something if you don’t mind, I’m going to quote you reading this book. It’s page 10 everybody if you have the book. “In this book, I will talk about planning an elective Cesarean, planning a VBAC, having an elective Cesarean, having a VBAC, or having a repeat emergency Cesarean. There is no failure. You haven’t failed if you choose one birth mode but have another. You are amazing and your choices are valid. Be true to you.” That, to me, is so powerful. “Be true to you.” And no, you did not fail no matter what birth mode you chose or what birth mode ended up happening, right? Don’t you feel that, Sarah?Sarah: Yeah, I completely agree with that. I think it touches back into the trauma too that maybe you are not aware of that you’ve experienced and really fear-clearing and taking the time to process your previous birth knowing that whatever the outcome is for your next journey, you’re not that failure. You’re fine and perfect. You’re enough. Hazel: Absolutely. Meagan: Mhmm. You are enough. Yes. Hazel: The research, when you read it, is really full of emotive damaging words when it comes to VBAC. Saying that women are a trial of scar or a trial of labor, we are not criminals for wanting to have a vaginal birth and when we use that language in research, then it means OBs and clinicians and nurses and midwives will use that language as well and tell you that you’re on trial. What do you imagine when you think of that? You’re not thinking about, “Is this uterine scar going to survive?” You get a feeling that you’re a criminal and you’re not just because you want to have a vaginal birth. I even challenge researchers. Take that language out. You don’t need it. It’s unnecessary. I’ve been writing a paper with some OBs over here recently and just saying, “I won’t be on it if you use the term ‘trial.’ I won’t be on it if you use the term ‘failed’ or ‘succeeded’. Just take the emotive words out and call it what it is.”We have to show by example as well and not have that language in the papers that are influencing policy, guidelines, and practitioners. Meagan: Yeah. Sarah: There is such power in the language and the words that we use. Absolutely. Meagan: Mhmm, yeah. Well, Hazel. It has been such an honor to chat with you. Like I said, I feel like we could go on and on and on. Maybe we just need to have you back on. Maybe we need to do something even bigger and do a webinar with you because you have such a wealth of knowledge and we’re so grateful for you. Like I said everybody, we will have the link for her book Birth After Cesarean: Your Journey to a Better Birth in our show notes. So Hazel, before we go, do you want to share where everyone can find you? I’m going to be sharing you all over our social media as well. We’re going to have everything in the show notes, but tell people where we can find you. Hazel: Yeah, sure. I’m on Instagram at @hazelkeedle. I’m on Facebook at VBAC Matters or Hazel Keedle, VBAC Researcher. That’s where I share my book information but also future research that I’m doing as well. I’d love to come on and do a webinar with you and talk further about this anytime even at 2:00 in the morning. Meagan: Even at 2:00 in the morning! You are amazing. We are so grateful to you. Seriously, thank you so much, Hazel. Yeah. I can’t wait to share this episode with the world. Hazel: Thank you for having me. Sarah: You know, a lot of what we talk about in the episode is so important and so true to how I feel too. I think calling out trauma has been something that’s really near and dear to my heart and something that I had to do to prepare for my own VBAC, so I definitely recommend anybody that is going through this journey to make sure that you are taking the time to really heal from that previous birth and taking time to process and doing some fear clearing and even physical healing from the scar and doing scar massage and such like that. Also, I really think it’s important to find that support and build that relationship like Hazel was talking about. Make sure you have somebody that you are able to build a relationship with and feel comfortable with because that’s going to matter so much when it comes to your birth. And also, finding a doula that you have a good relationship with, not just your provider. I think those are really main things that I really try to instill in anyone that’s going for a VBAC. Meagan: Absolutely. I 100% agree and Sarah, we are so happy to have you in our VBAC Link doula community. Can you tell everybody where they can find you as well? Sarah: Yeah, sure. I am in Simpsonville, South Carolina. It’s in upstate South Carolina. More commonly, I guess you’d be familiar with Greenville, South Carolina. I am in that area. You can find me, mostly I hang out on Instagram, so either @sarah_marie_bilger or Entering Motherhood. You can find me there on Instagram. We’re actually planning on starting up local VBAC support groups.Meagan: Oh, amazing. Sarah: So if anybody is around and in the area and interested in doing that, there’s going to be me and another doula in the area. We’re excited to start that and really provide in-person support for people either that have had Cesareans, may be thinking of a VBAC, or really just any realm of Cesarean/VBAC. If you’ve already had your VBAC and you want to come share your story of success to motivate and help women that are preparing for it as well, we’re going to include story sharing and different topics to cover. Meagan: Absolutely amazing. Awesome, awesome. When all of that information is available if you wouldn’t mind shooting that over to us, we will make sure that the world knows that. Awesome. Well, thank you so much for co-hosting with me today. It was such an honor to have you. Sarah: Thanks for having me. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link. Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands